ATTACHMENT B- IECMHC APPLICATION QUESTIONS_RFA-FINAL.docx

Infant and Early Childhood Mental Health Consultation (IECMHC) Regional Service Provider (RSP) RFA Questions

Section A: Applicant Information

Question 1: Legal name of applicant, including any assumed business names (if different from legal name):

Question 2: Federal ID # or Tax ID #:

Question 3: Unique Entity Identifier (UEI) #:

Question 4: Address of applicant agency:

Street address:

City:

State:

Zip code:

County:

Question 5: Authorized contact person for general issues and questions about the application:

Name:

Title:

Email:

Phone Number:

Question 6: Authorized contact person for issues and questions about the program description and implementation:

Name:

Title:

Email:

Phone Number:

Question 7: Authorized budget contact person for issues and questions about the budget:

Name:

Title:

Email:

Phone Number:

Question 8: Authorized individual to sign contract. Indicate the address where the contract should be sent.

Name:

Title:

Email:

Phone Number:

Mailing Address:

Question 9: Organization/Entity Type. What type of organization or entity is the applicant? (Choose all that apply.)

· Child Care Resource & Referral Agency

· Community-based organization

· Community mental health organization

· Coordinated Care Organization

· Culturally specific organization

· Disability-specific organization

· Early Learning Hub

· Early Intervention/Early Childhood Special Education (EI/ECSE) Contractor

· Federally recognized Oregon Tribal Nation

· Relief Nursery

· Other Health Care Organization

· Other: _________________

Regional Location Each of Oregon’s regions and the communities within regions are unique, with its own priorities, values, and needs. As such, it is important for IECMHC Regional Service Providers to be established in and representative of the region they wish to serve.

If the answer to Q11 or Q12 (below) is no, then your organization is not eligible to apply for this opportunity.

Question 10: Which region is the applicant applying to provide services in? ___________

· Blue Mountain (Union, Morrow, and Umatilla Counties)

· Frontier (Grant and Harney Counties)

· South Central (Douglas, Klamath, and Lake Counties)

· South Coast (Coos and Curry Counties)

If you are not sure which region you are in, you may look up that information here:

· Child Care Resource and Referral Regional Map (https://oregonccrr.org/) Question 11: Does the applicant organization currently provide services within this region? Y/N Question 12: Does the applicant organization maintain a physical location (i.e. owns or leases an office building, housed in a school building, or similar situation) in the region for which it is applying? Y/N Question 13: Is the applicant organization’s headquarters (“main office” or fiscal office) located within this region? (Y/N)

· If no, provide the location of organization’s headquarters and describe the business relationship between the regional location and headquarters, and in what way the headquarters is connected to and representative of the regional community.

Section B: Community Connections We would like to learn more about your organization. The following questions will help us understand your organization's story, the people that work there, the services you provide, and the communities you serve and have relationships with.

Question 14: Share your organization's story and include a brief history of why, how and when your organization began. Share about your organization’s values, mission and purpose. Describe the current services offered in the region.

Question 15: Which ECE types does your organization serve:

· Certified Child Care Centers

· Certified Family Child Care

· Registered Family Child Care

· Head Start

· Early Head Start

· Oregon Prenatal to Kindergarten (OPK)

· Relief Nurseries

· None of the above

· Other: ___________________ Question 16: Does your organization provide direct services in languages other than English (without interpretation)? (Y/N)

· If yes, indicate in what languages staff provide services. If no, please describe how organization provides culturally responsive services to people whose primary language is other than English.

Section C: Coordinated System of Support A critical component of a system-level strategy to prevent suspension and expulsion is establishing a coordinated system of support. This consists of two primary elements:

1) DELC is establishing a Warmline: an online access point for ECE providers to submit a request for support. The request may be made with a specific child in mind or for help in implementing classroom or programmatic practices to promote inclusion. Regional Service Providers will be responsible for monitoring Warmline referrals and working with other system partners to determine the best person or the best role to respond. For example, in some cases, the best person to respond may be a Coach who has a pre-existing relationship with the ECE provider. In other cases, the best person to respond may be another Technical Assistance provider or the IECMH Consultant.

2) Establishing collaborative partnerships, or utilizing existing ones, among ECE system partners to provide behind-the-scenes coordination and alignment among Technical Assistance providers, IECMHC, EI/ECSE, or other partners. The goal is to ensure an ECE provider requesting support is connected to the right services for their need, and that services offered by more than one service provider are not contradictory.

Question 17: With which of the following system partners does your organization have already-established collaborative partnerships? Mark all that apply:

· Child Care Resource & Referral (CCR&R)

· Early Learning Hub

· Early Intervention/Early Childhood Special Education (EI/ECSE)

· Early Childhood Behavioral Health

· Tribal Nations

· Culturally-specific Organizations; Specify: ________________

· None of the above

· Other; specify: _________________________ Question 18: With which of the following system partners will your organization establish collaborative partnerships during the planning period? Mark all that apply:

· Child Care Resource & Referral (CCR&R)

· Early Learning Hub

· Early Intervention/Early Childhood Special Education (EI/ECSE)

· Early Childhood Behavioral Health

· Tribal Nations

· Culturally-specific Organizations; Specify: ________________

· None of the above

· Other; specify: _________________________

Question 19: Describe why the applicant organization is interested in adding (or expanding) IECMHC to its region.

Question 20: Describe briefly how you will work together with other local organizations to decide who will lead the implementation phase of this work? How will you coordinate different organizations/partners and connect providers to supports?

Question 21: Does your organization commit to collecting demographic information and information on the number of children, parents or caregivers, and/or ECE providers served within your region?

Question 22: How long does your organization anticipate the planning period will take? (Planning periods are limited to a maximum of 12 months).

Section D: Equity-Centered and Trauma Informed Organizational Policies and Procedures Question 23: Does your organization agree to participate in the planning process with other selected Regional Service Providers, the Central Entity, and DELC, and identify an RSP for your region?

Question 24: The list below reflects DELC’s priorities for Regional Service Providers. Do you agree to work with your community partners to identify a Regional Service Provider who will commit to the criteria below?

· Providing 1:1 supervision for staff

· Financially supporting the professional and career development of staff

· Recruiting and retaining staff who are Black, Indigenous, or other people of color

· Establishing compensation policies and a reasonable timeline for creating a minimum annual salary structure that allow IECMH Consultants to be compensated at a minimum annual salary of $70,000-75,000 for an entry-level consultant

· Exploring compensation policies that allow an incentivized compensation structure above the base salary scale that recognizes the lived experience, community knowledge, and other ways of knowing of IECMH Consultants who are Black, Brown, Indigenous or other people of color

· Establishing compensation policies that allow an incentivized compensation structure above the base salary scale that recognizes the linguistic abilities of IECMH Consultants able to provide services in the first language(s) of historically underserved immigrant and diaspora communities

· Exploring policies and procedures at the organization and/or program level to dismantle the systems of oppression that harm and create disparities for communities who are historically and institutionally excluded

· Embedding trauma-informed care into organizational policies and practices, and applying these policies and practices to IECMHC

· Participating in the development of an IECMHC Equity Workforce Development Plan that incorporates all of the above.